The Affordable Health Care for America Act in a nutshell -Title I
The House has published its health care reform bill – almost 2,000 pages of it.
Rather than simply do a piece highlighting parts of the entire bill, I thought I’d make you all really smart by giving you a ‘nutshell’ version of what each title of the legislation includes, beginning with Division A, Title I.
Division A – Title I
Section 101. Page 16.
Provides ‘bridge’ insurance coverage to high risk individuals who have been uninsured for a six month period. The insurance will be provided by the government, begin on January 1, 2010, have high deductibles up to $1500 but cap out of pocket expenses at $5,000 for an individual and $10,000 for a family. The program is intended to cover those who cannot otherwise get coverage until the health exchanges are up and running. At that time, this program will end, with HHS obligated to help participants find similar coverage through their state health exchange.
Section 102. Page 26
In order to insure value to customers and lower premium costs, this section effectively states that in any given year where a health insurer pays out less money than the medical loss ration established by the Sec. of HHW, the insurance company will be required to provide rebates to its customers. The theory here- and a pretty good one- is that if insurers are skimping on spending money on care or charging too much in premiums, they are not going to be able to pocket all of the benefits. If they have to rebate a portion to customers they might as well either provide better care or lower premiums.
Section 103. Page 28
Written to end the practice of health insurers rescinding coverage after someone gets sick. Insurance companies will be prohibited from cancelling policies absent clear and convincing evidence of fraud. The section further requires that an outside, independent, third party review be set up for appeals by consumers.
Section 104. Page 31
Requires insurers to annually submit an explanation to HHS,explaining and defending proposed premium increases. The section does not indicate if HHS can do anything about if the Secretary disagrees with a proposed price hike.
Section 105. Page 32
Allows kids to stay on their parents health insurance policy until they are 27, so long as the kids are not otherwise insured.
Section 106. Page 37
Shortens pre-existing condition waiting periods in group policies to 3 months. Currently. most group policies you join require a 6-12 month waiting period on an existing condition until you are covered. After 5 years, there will be no waiting period as all previous conditions will be instantly covered upon becoming insured.
Section 107. Page 41
Prohibits the current insurance practice of defining domestic violence as a pre-existing condition.
Section 108. Page 42
Prohibits insurance companies and employer plans from excluding coverage for minors with congenital or developmental deformities and disorders. This corrects the problem of health insurers denying coverage for birth defects, etc. by calling this type of surgery “elective” surgery. Minors are defined as anyone under 21. However, the provision specifically excludes cosmetic surgery to reshape normal structures – so no nose jobs, breast augmentations or liposuctions on the insurance company!
Sec. 109. Page 49
Eliminates lifetime caps and limits on health insurance plans, beginning Jan. 1, 2010. This would require insurers to cover per the policy with no limit on how much they have to pay out over a lifetime.
Section 110. Page 53
Protects retiree health care benefits from being reduced after beneficiaries have already retired. This is huge for retirees who are finding themselves with reduced health care benefits as the companies they used to work for encounter serious financial problems. Under this provision, retirees will be protected from losing what they were promised when they were employed.
Section 111. Page 56
Creates a temporary government reinsurance program to protect retiree benefits. This,essentially, gives effect to Section 110 by putting the government behind the promise that no retiree will lose his or her benefits.
Section 112. Page 62
Creates Wellness grants to small businesses. The government will pay 50% of the cost of qualifying wellness programs conducted by small businesses.
Section 113. Page 70
Continues the current extension of COBRA eligibility period which was put in place late last year in response to everyone losing their jobs.
Section 114. Page 72
Creates grants to the states to fund programs designed to expand health coverage to the uninsured. The money is meant to encourage local and statewide programs such as community based insurance and reinsurance programs, purchasing collaboratives, etc.
Section 115. Page 76
Requires that within 2 years of passage, standardizing electronic administrative procedures have to be put into effect that simplify claims and payments, information sharing, standardized claims forms, etc. While this is less ’sexy’ than other provisions, this is huge. 30% of every dollar spent on health care goes to administrative costs – much of it unnecessary. This provision could do more to save money in the health care system than almost any other thing Congress could do.
I have to say that there is some great stuff here. Look forward to comments.
Next up – Title II -Protections and Standards for Qualified Health Benefits Plans
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Very helpful Rick, many thanks.
Rick I really don’t get why some on the left see the payments tied to Medicare being eliminated as such a loss. Maybe can enlighten me if you’d be so kind. For me it’s not such a big deal. I think it’s a small price to pay for blue dog support and I see it as being a valid issue for the blue dog’s side.
It doesn’t bother me all that much either. The concern is that, under the plan the House went with, it will fail to keep premium costs down for consumers because the public option will (i) have to negotiate with providers like the privates which means higher rates and (ii) because the actual number of people that will qualify for the public option – at least at the outset when the numbers are not very big – the public option, which now has to negotiate on an even footing- will not have the bargaining power necessary to accomplish significantly lower payment rates.
In response to another comment. See in context »I have to say that when you see all that is included in the bill, it’s pretty sweet and more than enough to overcome a weaker public option. The question now is how much of it will survive.
For me it’s all about “getting a foot in the door”. Was glad to see Howard Dean endorsed the house bill.
In response to another comment. See in context »That’s all pretty good shit. I’ve already begun sending this to people to tell them how full of it they are. “See? Your retarded baby would still be covered! This Ezekiek Emanuel crap is nonsense!” Kind of reminds me of the excellence of the first and second Spider-Man movies.
Did you put the kabosh on the Tom Cruise’s interest in Iron Man? Also, did you have to calm Joe Quesada down when the first X-Men movie brought back Wolverine’s cigar habit?
I look forward to Part Deux.
Glad you liked the piece….and you know I don’t talk Marvel here!!!!
In response to another comment. See in context »This is good stuff…thanks for the summary…I’m beginning to be a happy camper…let’s hope the big stuff survives…and the democrats can keep a majority long enough to improve the bill in the future.
I must say that my despair lately has been lifted…the public has really come to it’s senses and the pressure is showing…maybe my weekly letters did have some effect…do you see any big hurtles, other than the filibuster, which I am looking forward to, that may be a game changer?
I”m summarizing Title II right now and it continues to be a very good bill. Hope it can make it through reasonably intact.
In response to another comment. See in context »Everyone I am talking with about the bill seems surprised at how good it appears on the first read. I am waiting for the wing nuts to “read in” some outrageous interpretation over the coming days but right now the doc’s are pretty happy and actually hoping the good things will survive the assualt coming from the insurance industry.
So how is this revenue neutral? I see many benefits, but no cost savings – maybe that’s Title II
I like the benefits though; it seems far better than my current plan.
There’s a difference between ‘revenue neutral’ and ‘deficit neutral’. The idea is to do all of this without increasing the deficit over the next ten years as a direct result of the bill. If we can believe the CBO, this should do it. We’ll see.
In response to another comment. See in context »There is revenue in the bill – but it does come later. Primary it is a surcharge of individuals who aren half a million and families that earn a million a year. Also, the approach is to modify the system of payment to better reward outcome and move away from pay per service in order to bring down costs.
At the end of the day, nobody is really going to know if this will end up extending the deficit or not. But, as you say, you gotta like the benefits.
It’s a watered down piece of crap,just what I expected from these compromised corporate Dems.
Sounds like you’ve been watching Ed Schultz. The purpose of me taking the time to do this synopsis version, is so people like you can actually read it before reaching such strong conclusions. Have you read it???????
In response to another comment. See in context »